TUITION ASSISTANCE GRANT APPLICATION
FOR CCC ADULT EDUCATION COMPLETERS
(2020-2021 Academic Year)
2800 S Lone Tree Rd Flagstaff, AZ 86005-2701 PH: 928-226-4219 FAX: 928-226-4110 firstname.lastname@example.org
Tuition Assistance Grant (TAG) is a one-time grant of standard Arizona resident tuition for one, 3-credit CCC course for residents of
Coconino County who have completed the CCC’s Adult Education program within one year before start of term. Completion of CCC’s
Adult Education program is defined as receiving a High School Equivalency (GED) or achievement of National Reporting System (NRS)
level of 4 or higher in the English Language Acquisition for Adults (ELAA) program after receiving instruction from the CCC Adult
Education program. Funds can only be applied towards tuition. Students must use the TAG waiver within one year of receipt of the
GED or completion of ESL level 4 or higher. TAG can only be used to pay standard tuition and will automatically credit the student’s
account. It does not pay differential tuition amounts, fees and books, etc. If a student has a hold on his/her account, it must be resolved
before the TAG will be awarded. It is recommended that students also file a FAFSA and complete a financial aid file in order to see if
they qualify for additional money. College scholarships, waivers and loans may be reduced to account for other aid, or in some cases
other aid may be reduced to avoid awarding more than the student's calculated need.
In order to qualify for TAG, recipients must meet the following three items:
_______Initial Here I am a Coconino County Resident
_______Initial Here I received my GED or achieved NRS Level 4 or higher in ELAA within the last year after instruction at CCC
_______Initial Here I have attached a copy of my official GED transcript or copy of TABE CLAS-E results from CCC
Most male students must register with the Selective Service System between the ages of 18 and 25 in order to qualify for aid containing
state monies. Please initial whichever below applies to you.
_______Initial Here I am a male and am registered with selective service
_______Initial Here I am a male and am not registered with selective service
_______Initial Here I am a female
*Some CCC scholarships, waivers and grants are funded in part or in whole with Arizona state monies. These funds are governed by Arizona State laws. They
are not available to a person who is not a citizen of the United States who is without lawful immigration status. This rule applies to all tuition waivers, fee waivers,
grants, scholarship assistance, financial aid, classification as a resident for tuition purposes, tuition assistance in general, or any other type of financial assistance
that is subsidized in whole or in part with state monies. The Office of Student Financial Aid confirms your eligibility by referencing (a) the Residency Statement
and documentation you provided to the Office of Registration and Enrollment Services and/or (b) the Free Application for Federal Student Aid (FAFSA). CCC is
required to report to the State of Arizona students who apply for financial aid that includes state monies and are denied due to not being lawfully in the U.S.
Failure to submit a Residency Statement to the Office of Registration and Enrollment Services may disqualify you for financial aid that contain state monies.
I certify that information provided on this form is true and complete to the best of my knowledge. Purposely giving false or misleading information may result in
a delay or denial of my federal financial aid and I may be fined up to $20,000, sent to prison or both. I hereby provide consent for the use of electronic records
and signatures on all financial aid documents. I understand that if I choose to sign electronically, my electronic signature constitutes a binding contract and
may not be denied legal effect, validity, or enforceability solely because it is in electronic form or because an electronic signature or electronic record was used
in its formation.
Student Signature and Date How do I create a digital signature with Adobe?
CCC ID# Last Name First Name MI
Mailing Address City ST Zip Code
Telephone No. (include area code) Email Address
Office of Student Financial Aid Use Only
GED Trans or TABE-CLAS-E Results Attached? Yes No GED < 1 Year Ago? Yes No
Does student have SOAHOLD ? Yes No Is student a County / AZ Resident? Yes No
Application: Approved Denied Amount $ Processed By:
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